Friday, October 09, 2020

Medicare’s Annual Election Period (AEP)

Each Fall, Medicare offers Individuals, called beneficiaries, an opportunity to make changes in their plans which work with Medicare to process all treatment and services or to pay providers the part of treatment and services expenses Medicare doesn’t. 

• Medicare calls these times to make a change or sign up periods, and the one taking place each Fall is the AEP. It currently is from Oct 15 to Dec 7.

• The AEP is for people enrolled in a Medicare Advantage (MA) plan and those with a stand-alone Prescription Drug Plan. Individuals in CT with a Medicare Supplement can make changes at any time.

My focus is to eliminate confusion people may have about Medicare and the Medicare Health Plans. Thus, as we approach this year's AEP, I want to share some factual information about enrollment periods. This page from my Medicare Health Plans site has factual information.

Regretfully TV commercials throughout the year lead people to think they can change whenever they want, which they cannot. Ads use misleading statements such as - call to learn about new benefits you can have.

Another confusing thing about the time to make changes each Fall is sometimes incorrectly called an Open Enrollment Period. (OEP) The OEP however is not in the Fall. It is the first part of the year. It’s for people who are not happy with their specific Medicare Advantage plan to make a change. Technically it is the MA OEP and available Jan 1 through Mar 31.

You gain a lot more when talking with a health insurance advisor about all your options vs someone from one company!


John C Parker, RHU, LTCP

Niantic CT


Thursday, September 24, 2020

Making the regulation of Medical Insurance better!

Political ads and talking heads say - ACA is great - need to make it better! Really! Much of what is reported on the ACA is not correct  Working with Individuals and small employers I can list many issues. However, instead, I am sharing some research on what the health reform regulations in the ACA did. 

The research was reported in a Sept 23rd Forbes article. You can find all the details here.

The Galan Institute created a summary of the article. I am sharing two parts of it here between [snip].  I added bold to emphasize some of the Galan text.

[snip]

Blase notes that despite spending $50 billion in taxpayer money on premium subsidies, individual market enrollment is up by just 2 million people from pre-ACA levels—a staggering $25,000 tab per newly insured. Exchange enrollment is 60 percent below expectations given how unattractive the products are to middle-income families. 

[snip]

[snip]

"Calling the law ‘The Medicaid Expansion Act’ seems more appropriate than ever since 100 percent of the net reduction in the uninsured has occurred because of Medicaid. A massive expansion of Medicaid—a welfare program that traditionally served low-income children, pregnant women, seniors, and individuals with disabilities—is not what the ACA’s proponents talked about when selling the law to the American people."

Fortunately, the policies of President Trump reversed some of this damage. Blase discusses actions to shore up the exchanges as well as expand more affordable options through Association Health Plans (AHPs) and short-term plans. 
 
A Council of Economic Advisers report found that these expanded options, along with eliminating the individual mandate tax penalty, generate $45 billion in net economic benefit each year for Americans. 
 

And the Trump administration’s health reimbursement arrangement (HRA) rule, which allows employers to offer tax-free payments that workers can use to purchase individual market coverage, is expected to add 8 million people to the market—four times as many as the ACA with no new federal spending. 
 
While the Trump administration made great strides to help Americans harmed by the ACA, Blase argues that “A better approach would be freeing people to purchase coverage that best meets their needs and budgets, allowing states to establish safety net programs to ensure people with pressing health care needs receive the care they need, and transitioning as much government assistance as possible directly to consumers rather than funneled to health insurers.”

[snip]


Want to specifically refer to certain words from the Galan summary - "as well as expand more affordable options through Association Health Plans (AHPs) and short-term plans. "

This refers to a federal program created to allow states to implement two ways to help individuals.  Guess what!  - CT decided individuals here in CT can not take advantage of these programs to save - they were not approved.


John C Parker, RHU, LTCP

Niantic CT



Tuesday, August 18, 2020

Two particular words — MediCare uses when signing up!

People report being confused when online looking for when can I sign up for MediCare and when does it start! That’s understandable since online info. is often “not quite accurate”! Thus, my post is to answer the “when can” and “when does” questions and review two special words used in signing up.

The first word in MediCare’s eligibility & signing up regulations to review is  — “eligible.” Social Security (SS) manages eligibility regulations and CMS manages coverage details.  These regulations, which I call “rules”, define eligible as a month not a specific date and it’s the month a person becomes 65. If a person does decide to apply at 65 they have what’s called an Initial Eligibility Period (IEP) to complete an application.

 

The IEP is seven months, with their eligible month in the middle, and they can —  complete an application:

● Any month before eligible. If they do, both Part A & Part B start the first day of their eligible month. 
    Note: Eligible month is moved to the previous one when a birthdate is the 1st


● During their eligible month or any month after. If they do:

   + Part A continues at the first of their eligible month.

 

  + Part B will be different! Why? “Rules” say it starts the:

        - Next month if a person signs up the month when 65

        - Second month after if sign up the month after 65. 

        - Third month after if sign up either the second or third month after 65. 

 

Signing up in the IEP’s last month — means Part B is six months after A.  Having effective dates, other than the first of the next month, is confusing. To further complicate this SS decidedPart A will also be backdated six months from the date of a person’s Part B for everyone who signs up six months or more after eligible! Do not know the logic of why this is done.

   Note: Going back six months means a person with a HSA has to stop making contributions six months before leaving employment and starting Part B.

 

The second word in the eligibility “rules” to review is  "entitled".  MediCare applies this term to everyone who has completed signing up. Entitled therefore is the date a person’s coverage begins for:

    + Part A’s inpatient hospital services and

    + Part B’s medically necessary outpatient services.

 

BTW — we know entitled is important because MediCare puts it on a person’s ID card! It’s printed above Part A and Part B to show when each coverage started.

Bottom line – when talking to individuals I use the official words.  MediCare refers to individuals as beneficiaries and I believe it’s important for new and current beneficiaries to hear correct names even though people often read or hear other words, such as:     

    + entitlement date instead of eligible

    + enrolled instead of entitled

 

John C Parker, RHU, LTCP

Niantic CT

Saturday, July 25, 2020

More deceptive ads about MediCare on cable TV!


There was one, now two companies, flooding cable TV with MediCare ads here in Southeastern CT.  I see them on the Weather Channel,.

The focus of these deceptive ads is to encourage everyone who has Medicare – call right now to get all these better medicare benefits!

Why are the ads deceptive?

  Individuals on Medicare cannot get additional benefits directly from MediCare nor by buying a Medicare Supplement. Additional benefits are only available by signing up for a Medicare Advantage plan, which normally is only done during MediCare’s Annual Election Period each Fall. It runs from Oct. 15 to Dec. 7.

  Then too, some of the “you can get” benefits listed in the ad are just available in Special Needs Plans (SNP) and not available to everyone! More deception! Only individuals with certain medical conditions can qualify for a SNP!

  One benefit mentioned in the ad – rides to the MD – is only available in what is called a Dual Special Needs Plans (DSNP). Only individuals who qualify to be on Medicaid (welfare) can sign up for a DSNP.

 The former sports figures in the ads –  saying I called and got these benefits – would never qualify for these special plans!

 To make matters worse – another company, whose name is sort of connected to the medical field, has an ad in Southeastern CT for a Medicare Supplement – but it is not approved in CT! More reason to beware!

MediCare considers a person “eligible” the month when 65. So yes, someone can sign up during the three months before 65, the month eligible, and in either of the three months after. MediCare calls this sign-up time an Individual’s Initial Election Period.  However, the ads do not say – call if you will soon be 65.


I help individuals with MediCare’s complex sign up rules as a health insurance professional. I also help simplify and understand what I call Medicare Health Plans and when interested to sign up. MediCare's marketing rules to work with these plans are complex and get into what I can say and when I can talk about benefits. Thus, it’s frustrating when the restrictions I have to follow do not apply to companies creating TV ads!

Interested in learning more about the two types of – Medicare Health Plans? This page has information on the two types and times to sign up. It is from one of my web sites and may be helpful.


John C Parker, RHU, LTCP
Niantic CT

Saturday, June 13, 2020

Sharing — facts on signing up — for MediCare!



People tell me they are confused about what they found on MediCare. This is certainly understandable because when you Google signing up you find:

• Explanations using incorrect words for something. For example, Social Security enrollment rules and words from Medicare do not say enroll.

• Points on what to do and when are not correct.

• Information from a long time ago about – people need to/must sign up when they turn 65. Deciding when to sign up is the responsibility of each person/

Because of incorrect information like this and others and questions I hear it is important for people to know what to do and when.

Thus, I am pleased to share — factual information about the sign-up rules on this link  It's from one page on my Medicare Health Plans web site.


John C Parker, LTCP. RHU

Saturday, May 30, 2020

Signing up for Medicare Part B after working past 65 is somewhat complex but it is now a little easier!



Individuals signing up for Medicare, whether at 65 or later after working past 65, do this through the Social Security (SS) system. There is an application for Part B (outpatient services) to complete, which also activates Part A (hospitalization situations). When working after 65 Part A is backdated six months from the date assigned to Part B.

Individuals working past 65 have another form to complete. They take it to their employer, dates covered by the company medical plan are listed, it is signed, and return to the SS office. This form gives them a Special Enrollment Period to sign up for Part B and avoids paying a late enrollment fee. SS offices have been closed so this process has been complex.

Pleased to report SS announced May 28th a way for a person, leaving an employer plan and wanting to sign up for Medicare, to complete the forms online. Information about this, the steps to be completed, and a link to begin to apply can be found here.


Friday, May 01, 2020

Beware of deceptive Medicare TV ads!

One company has flooded cable TV here in Southeastern CT for some time with – call to get better Medicare coverage – ads!

Why are the ads deceptive?

  A person on Medicare can only get additional benefits in a Medicare Advantage plan, and some of the “you can get” things mentioned are not available to everyone. Just individuals who qualify for a Special Needs Plan!

  Also, eligibility for the Dual Special Needs Plan with additional benefits such as – rides to the MD is connected to income. The sports figure –  saying I got these – would never qualify for this coverage!

  The ad encourages everyone on Medicare to call today. However, the only time people living in Southeastern CT can change their Medicare health plan is in the fall during the Oct 15 to Dec 7 Annual Enrollment Period.

  Yes, someone turning 65 can sign up in any of the three months before, the month when 65, and during the three months after.  However, the ad does not say – call if you will soon be 65.

To make matters worse – a second company now has a Medicare ad – thus more reason to beware.

The Medicare system has complex rules on what I, as a health insurance professional, helping people with Medicare, can say and when. Thus, this is frustrating to me when the same restrictions do not apply to TV ads!

John C Parker, RHU, LTCP
Niantic CT

Monday, March 09, 2020

A look at ideas to “fix” the cost of medical insurance!


What might be a solution – wishful thinking? – work on the problem?

What about – wishful thinking – lots of ideas in this category regularly come from Washington DC. They are along the line of - Oh – the government can do it better. Guess what – they are also coming from Hartford CT. 

My response to these – really! Where has it been effective?

Let’s take a quick look at working on the problem. 

First: Some things being found in research: 
  A recent article reported on a study by Brigham and Women's Hospital researchers. Its focus was heart health and found if people followed a proper diet could save about $50 billion a year! A couple interesting points from the article:
->That dwarfs the $8 billion we just allocated to battle a new virus, COVID-19,”  

-> “ Not surprisingly, eating too much processed meat is super expensive to your health. And not eating enough nuts, seeds, and omega-3 rich seafood also proved to be costly.”

  An article from Harvard’s School of Public Health includes three lists of foods and their impact on blood sugar. Foods with low, medium, or high glycemic load. For good health work to use foods with a low load and stay away from food on the high load list. You can view the article here.

BTW – Working for good health does not mean just use less sugar. People do not realize flour can be worse than table sugar.


Second: Some things in the area of “Disruption”  Albert Einstein once made a point that really applies to medical treat/insurance today – “Can’t solve problems with the same thinking that created the problem”.

  Steps are being taken by non-health insurance companies/organizations to change things. I have been watching this closely. One example:

Walmart is testing out a new health center. - - - may expand its initiative across the United States, potentially upending the way millions of Americans receive medical care. The articles about “Walmart Health” have indicated - Patients:
    ->  Have a separate entrance next door to a massive Walmart supercenter,

    -> Can see doctors for routine checkups and ongoing treatment of chronic illnesses, such as diabetes and heart disease, even if they lack health insurance.

    -> Can also get lab work, x-rays, dental care, behavioral health counseling, eye and hearing exams, and access to other services.

   -> Will use physicians at its health centers to replace their current primary care providers,

The bill for an annual checkup for an adult is $30 without insurance, an eye exam is $45 and dental exams cost $25. Therapy sessions are $60.



John C Parker, RHU, LTCP
Niantic CT


Saturday, January 04, 2020

An effective way to gain insight into your health


One of the things which happen to many of us as “time goes on” is the potential to develop health problems increases!


One effective way to gain quite a bit of insight into your overall health is to get a full eye exam by an optometrist or ophthalmologist. Insights into overall health are not available from, a vision check-up, such as reading letters projected on the wall.

A full vision exam is expensive, e.g., about $175, so the reaction of those who do: 
Not have insurance – I can see OK, so I don’t need an exam.

Have medical insurance but it's a plan which doesn’t cover a full vision exam as a preventive check-up; so, the cost most likely would be applied to their plan’s deductible. These people may also say – I can see, OK, so I don’t need an exam.

 Have MediCare can get a vision check, but not a full exam, so their reaction is – I can see OK, so I don’t need an exam.

Bottom line - Many people today do not have access to Vision benefits like many employers provide. Luckily these Individuals can now buy an Individual Vision Plan with coverage similar to employer plans. For example, with a low co-pay for an exam and a nice allowance toward the cost of frames.

Information about the Individual Vision Plans offered by VSP and details of the coverage is on this link to one of my web site pages. 

John C Parker, RHU, LTCP

Tuesday, December 24, 2019

When can I sign up for MediCare? I'll soon be 65


I'll soon be 65 – when can I sign up for MediCare?
This is a common question. When a person looks for information on when it's often confusing or incomplete. So to eliminate the confusion I am pleased to share the rules for those who decided to sign up when 65. 

Individuals:
  Are no longer automatically signed up at 65!
  Can apply in the 3rd, 2nd, or month before 65. MediCare says when 65 is the eligible month. Part A (Hospital) and Part B (Outpatient) coverage will be effective the first of the eligible month.
  Can apply during the eligible month. Part B is effective the first of the next month but A stays the first of the eligible month.
  Can apply the month after eligible, two months after, and three months after. Part B will be effective either two or three months after applying. A stays the first of the eligible month and can be as much as six months back from B!
Those are the rules SS follows for when a person can signup at 65. 

Let’s now look at how to sign up. An Individual can:
  Sign up through Social Security's online system which is responsible to enroll people in MediCare.
  Go to the Local Social Security office. I encourage people to do this. Why? A face to face meeting with a retirement person is easy, less confusing for most, and they will: 
    + complete the Part A & B application for them, 
    + review the options to pay the 25% share of Part B's monthly base cost so the one best for their situation can be selected. B’s base cost is $144.60 in 2020.
       Note: An additional amount is added to B's base cost if the IRS 1040 AGI from two years ago is above 87 k for Single & 174 k for Joint. The rules for higher-income individuals have five other higher income levels’ and each adds an additional amount to B's base cost.
    + review SS's informative charts which are helpful in deciding the best age to start receiving benefits.

When a person has completed the signup MediCare considers them "entitled". [not enrolled]  They are then covered by:
       Part A for inpatient care in a hospital.
       Part B for medically necessary outpatient services.
       + The MediCare ID card shows entitled above Part A & B.